Membership Application Form

How to join

The current annual subscription is £3 for individual or £5 for family membership. Print this screen, complete the
form and send to Pat Lippiatt, Secretary DCPS, 135 Heath Lane, Dartford, Kent, DA1 2TW

Dickens Country Protection Society

Name


Address




Phone


Email



I enclose cheque or postal order for :-
£3 for Individual Membership
or £5 for Family Membership
(delete as applicable)